Market competition may not reduce costs or lead to greater efficiency in hospitals

The U.S. has the most expensive per capita health care system in the world. As such, one of the main goals of the Affordable Care Act (ACA) is to reduce costs for citizens. Morgen S. Johansen and Ling Zhu examine how private, non-profit, and government-run hospitals have responded to local market competition and the ACA. They find that administrators from public, non-profit, and private hospitals prioritize different aspects of care and costs in the face of market competition and that public hospitals are much more responsive to the ACA reforms

The refusal of 24 states to expand Medicaid under Obamacare will maintain their high levels of inequality in healthcare coverage

The United States is the only industrialized democracy that does not have universal health care coverage, and nearly one in five Americans do not have health insurance. The Affordable Care Act (commonly known as ‘Obamacare’) aims to extend health insurance to under and uninsured Americans by having them enroll in state or national “exchanges,” or online marketplaces; and by providing federal funds to states to expand their Medicaid coverage. Since the Act is implemented predominantly by the states, the benefits of the Act for uninsured Americans depends heavily on what states do, or refuse to do with Medicaid coverage and the state exchanges. Ling Zhu and Morgen Johansen examine what the U.S. states can do to address inequality in health insurance coverage

The ABCs of Communicating Results

Communicating results is an integral part of the internal auditor\u27s job, and The IIA\u27s International Standards for the Professional Practice of Internal Auditing recognizes its importance by specifying in Standard 2420 that communications should be accurate, objective, clear, concise, constructive, complete, and timely. In its 2009 survey. The Biggest Internal Audit Challenges in the Next Five Years, Protiviti, a global consulting firm, ranked communication with management and the audit committee as one of the biggest challenges facing internal auditing through 2012. Their subsequent 2010 Internal Audit Capabilities and Needs Survey identified presentation skills as the top need to improve personal skill of internal audit professionals. Clearly, the ability to communicate effectively continues to be an important issue within the profession. Any communication can be challenging — even when the news being delivered is positive — but when the news to be delivered is negative (e.g., identifying a control deficiency or alerting management to fraud), the job of delivering it can be even more stressful. In these situations, the internal auditor\u27s ability to communicate takes on increased importance. An organized, thoughtful approach can make that task easier and more constructive. Therefore, internal auditors should revisit some key steps to effective communication

Revisiting Joan Acker's work with the support of Joan Acker

This article is a personal tribute to working with Joan Acker. I worked with Joan in 2012, helping to edit her own thoughts and reflection on how other academics evaluate and used her own theorizing, specifically her seminal work on the gender substructure and inequality regimes. However, while this article is a tribute to Joan, her work and her thinking; it is also a personal thank you to someone I will miss for her generosity and also her activism in challenging inequalities in organizations and beyond. She continues to inspire me and hopefully others to challenge for social justice. In her 80s, Joan remained committed to addressing inequalities in social relations and how these were experienced within a dynamic social and work environment. During our collaboration, she called upon academics to put theory into practice to help address visible and invisible inequalities in organizational processes. This article is inspired by that experience and it will reveal Joan's views about her own, and other academics, theorizing of her two key concepts: the gender substructure of organizations and inequality regimes in organizations and the overlap with intersectionality. This article will offer a unique opportunity to gain insight into Joan's thinking as an academic sociologist as well as a feminist activist thereby uniting Joan as a person with her concepts

Quantum beat spectroscopy of repulsive Bose polarons

The physics of impurities in a bosonic quantum environment is a paradigmatic and challenging many-body problem that remains to be understood in its full complexity. Here, this problem is investigated for impurities with strong repulsive interactions based on Ramsey interferometry in a quantum degenerate gas of 39K atoms. We observe an oscillatory signal that is consistent with a quantum beat between two co-existing coherent quasiparticle states: the attractive and repulsive polarons. The interferometric signal allows us to extract the polaron energies for a wide range of interaction strengths, complimenting earlier spectroscopic measurements. We furthermore identify several dynamical regimes towards the formation of the Bose polaron in good agreement with theory. Our results improve the understanding of quantum impurities interacting strongly with a bosonic environment, and demonstrate how quasiparticles as well as short-lived non-equilibrium many-body states can be probed using Ramsey interferometry

Attitudes to and experiences with body weight control and changes in body weight in relation to all-cause mortality in the general population

Background and aimsIncreased body mass index (BMI = weight/height2; kg/m2) and weight gain is associated with increased mortality, wherefore weight loss and avoided weight gain should be followed by lower mortality. This is achieved in clinical settings, but in the general population weight loss appears associated with increased mortality, possibly related to the struggles with body weight control (BWC). We investigated whether attitudes to and experiences with BWC in combination with recent changes in body weight influenced long-term mortality among normal weight and overweight individuals.Population and methodsThe study population included 6,740 individuals attending the 3rd cycle in 1991-94 of the Copenhagen City Heart Study, providing information on BMI, educational level, health behaviours, well-being, weight half-a-year earlier, and answers to four BWC questions about caring for body weight, assumed benefit of weight loss, current and past slimming experiences. Participants reporting previous unintended weight loss (> 4 kg during one year) were excluded. Cox regression models estimated the associations of prior changes in BMI and responses to the BWC questions with approximately 22 years all-cause mortality with age as 'time scale'. Participants with normal weight (BMI ResultsCompared with stable weight, weight loss was associated with significantly increased mortality in the normal weight group, but not in the overweight group, and weight gain was not significantly associated with mortality in either group. Participants with normal weight who claimed that it would be good for their health to lose weight or that they were currently trying to lose weight had significantly higher mortality than those denying it. There were no other significant associations with the responses to the BWC questions in either the normal weight or the overweight group. When combining the responses to the BWC questions with the weight changes, using the weight change as either a continuous or categorical variable, there were no significant interaction in their relation to mortality in either the normal weight or the overweight group.ConclusionAttitudes to and experiences with BWC did not notably modify the association of changes in body weight with mortality in either people with normal weight or people with overweight

Type IV pili interactions promote intercellular association and moderate swarming of Pseudomonas aeruginosa

Pseudomonas aeruginosa is a ubiquitous bacterium that survives in many environments, including as an acute and chronic pathogen in humans. Substantial evidence shows that P. aeruginosa behavior is affected by its motility, and appendages known as flagella and type IV pili (TFP) are known to confer such motility. The role these appendages play when not facilitating motility or attachment, however, is unclear. Here we discern a passive intercellular role of TFP during flagellar-mediated swarming of P. aeruginosa that does not require TFP extension or retraction. We studied swarming at the cellular level using a combination of laboratory experiments and computational simulations to explain the resultant patterns of cells imaged from in vitro swarms. Namely, we used a computational model to simulate swarming and to probe for individual cell behavior that cannot currently be otherwise measured. Our simulations showed that TFP of swarming P. aeruginosa should be distributed all over the cell and that TFP−TFP interactions between cells should be a dominant mechanism that promotes cell−cell interaction, limits lone cell movement, and slows swarm expansion. This predicted physical mechanism involving TFP was confirmed in vitro using pairwise mixtures of strains with and without TFP where cells without TFP separate from cells with TFP. While TFP slow swarm expansion, we show in vitro that TFP help alter collective motion to avoid toxic compounds such as the antibiotic carbenicillin. Thus, TFP physically affect P. aeruginosa swarming by actively promoting cell-cell association and directional collective motion within motile groups to aid their survival.National Institutes of HealthIndiana Clinical and Translational Sciences Institut